Orthodontic Treatment in Periodontal Patients

Background: Orthodontic treatment poses significant challenges in patients suffering from periodontal disease. Providing orthodontic treatment to periodontal patients should be carefully planned and administered, with close collaboration between the orthodontist and periodontist in order to achieve the most feasible and stable results. Objectives: Present clinical recommendations based on literature review concerning orthodontic treatment of periodontally compromised patients. Methods: A 20 year timeframe Medline search from 1990 to 2010 was conducted. Inclusive criteria were clinical studies, case reports and reviews limited to human studies written in English on orthodontics and periodontics, orthodontic treatment and periodontal disease, orthodontics and chronic periodontitis. Relevant chapters written in contemporary textbooks were reviewed as well. Results: Fourteen reviews, four prospective studies and eleven case reports were the basis of our review .We present clinical recommendations for planning orthodontic treatment accompanying comprehensive periodontal treatment in compromised periodontal patients. Retention procedures and surgical periodontal interventions are essential to ensure stability of orthodontic results and to prevent relapse. The close collaboration needed between the orthodontist and the periodontist throughout the course of orthodontic treatment is emphasized. Conclusions: Resolution and stabilization of pre-existing periodontal pathology is a pre-requisite for the initiation of orthodontic treatment. Careful oral hygiene performance and frequent and proper periodontal recall visits are also crucial. Pre- and/or post- orthodontic periodontal surgery may assist in providing better and more stable treatment outcomes.